马来西亚一个三级保健医院早产儿视网膜病变的筛查
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首席医学网
2009年02月23日 20:52:40 Monday
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作者：M M Choo, U T Chan, N Khalidin, C T Lim 作者单位：马来西亚吉隆坡，马来亚大学医学院1眼科；2儿科
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【摘要】 目的：本研究旨在确定马来西亚一个三级保健医院早产儿视网膜病变的发病率及发病趋势。方法：回顾分析在20032005年之间出生并进行ROP筛查的婴儿，记录每个患儿ROP的最严重分期。 结果：我们对188名婴儿进行了筛查，平均出生体重1105.3±300.6g，平均妊娠期为29.2 ±2.6wk。这些婴儿整体的ROP发病率为29.18 % (55/188)。出生体重在750g及以下的婴儿发病率为76.2%。3a以来，低体重儿的数量及重型ROP病例数量呈现一个增长的趋势(P<0.05)。出生体重与婴儿受检数量之间存在负相关关系(P=0.000)。 结论：随着低体重和小月分婴儿比例的增加，患ROP的患儿比例随之增加。
【关键词】 ROP筛查；ROP发病率；危险因素
ICO Notes:Selected Presentations From
2008 World Ophthalmology Congress Available Online
Dear Colleagues,
I am writing on behalf of the International Council of Ophthalmology (ICO) to thank all those who contributed to making the 2008 World Ophthalmology Congress (WOC) in Hong Hong an outstanding success and to announce that selected presentations from the WOC are now available online.
Supported by a grant from Genentech, the ICO is offering the following at ico.scientificabstracts.org:
24 selected scientific and related papers selected from various symposia
more than 100 presentations from the first World Ophthalmic Education Colloquium (WOEC), on June 28.
The selected presentations and WOEC luncheon talks combine slides with audio. You will need to advance the slides manually to match the words of the speaker. The other WOEC presentations are slides only.
I encourage you to visit ico.scientificabstracts.org and see a sampling of what the 2008 WOC had to offer. Please let us know if you find it helpful to have these presentations available online.
By any measure, the 2008 WOC exceeded all expectations. Total registration was more than 13000, including 10500 ophthalmologists and other participants and 2500 exhibitors. The scientific program was broad and deep, thanks to the participation of 1100 speakers in 319 scientific sessions, many organized by more than 40 international, supranational, national and subspecialty ophthalmologic societies. The venue was terrific and the Opening Ceremony and other social events were captivating and great fun. (For more highlights and news from Hong Kong, see the ICO Web site at www.icoph.org.)
Congratulations to Congress President Dennis Lam, Scientific Program Committee Chair Steve Ryan and all the rest of the superb team that organized the WOC. Special thanks to all of you who contributed to the scientific program or supported the Congress in other ways.
The ICO would be interested in any comments or suggestions you have on how we can enhance the World Ophthalmology Congress. Send them to education@icoph.org.
Finally, please plan to join us at the next World Ophthalmology Congress, which will be June 59, 2010 in Berlin. For details, see www.woc2010.de.
With warm regards,
Bruce Spivey, MD, MS, MEd
President, International Council of Ophthalmology
945 Green Street, San Francisco, CA, 94133, USA
Fax: (1 415) 4098403
www.icoph.org·Original aticle·
Efficacy and safety of lowdose mitomycinC in the treatment of pterygium
Fang Zhao
Department of Ophthalmology, the Second Hospital of Yulin City, Yulin 719000, Shaanxi Province , China.
Abstract AIM: To observe the efficacy and the safety of lowdose mitomycinC (MMC) in the treatment of pterygium.
METHODS: In a prospective, randomized and controlled clinical trial, a total of 550 eyes of 400 patients diagnosed with pterygium were randomly divided into the four groupsgroup 1:130 eyes of 100 patients, without MMC; group 2:140 eyes of 100 patients, with 0.2g/L MMC; group 3:150 eyes of 100 patients, with 0.3g/L MMC; group 4: 130 eyes of 100 patients, with 0.4g/L MMC. They underwent the excision of primary pterygium barely the sclera. Visual acuity, intraocular pressure(IOP),extraocular movement,iridocyclitis,scarring, symptoms(tearing, photophobia, foreign body sensation) and signs (conjunctival hyperemia, ulcer of sclera and cornea, perforation of sclera) of subjects, were recorded on the day of enrollment, and after the surgery, on 2 weeks, 2 months, 6 months, and 1 year.
RESULTS: In group 3 and group 4, the recurrence of pterygium after the excision were less than that in group 1 and group 2 (P<0.01). In group 4, after the surgery, there were more probability of raising IOP, iridocyclitis, symptoms and signs than that in group 1, 2, and 3.
CONCLUSION: Lowdose MMC is effective in the treatment of preventing the recurrence of primary pterygium. Its efficacy rises along with its density. And meantime, the safety of the treatment of lowdose MMC declines.
KEYWORDS:lowdose;mitomycinC;pterygium;recurrence
Zhao F. Efficacy and safety of lowdose mitomycinC in the treatment of pterygium. Int J Ophthalmol(Guoji Yanke Zazhi)2008;8(11):21782181
INTRODUCTION
The pterygium is a fleshy, triangular encroachment of a pinguecula onto the cornea, usually on the nasal side bilaterally. It represents a pathologic condition, more frequently seen in certain populations, such as peasant, fisherman, and those persons who spend much of their times out of doors in sunny, dusty, sandy, or windy surroundings. So the pterygium is thought to be an irritative phenomenon due to ultraviolet light, drying, and windy environments. In tectology, pterygium is a fibrovascular connective tissue overgrowth of bulbar conjunctiva onto the cornea. An advancing pterygium can produce marked changes in refractive state and curvature before entering the optical zone[1 4], which can cause visual impairment[5,6]. And it also cause the various symptoms (tearing, photophobia, foreign body sensation), and cosmetic problem. In order to resolve these problems, many procedures have been described. The recurrence has been estimated as high as 30% to 70%[7], and is still the main complication.
The treatment methods, such as radiation therapy, conjunctival autograft[8], and the use of antimetabolites or agents, have succeeded in diminishing the recurrent rate to between 5% and 16%[814]. But some methods of these treatment are associated with serious complications, such as corneal perforation, scleral necrosis, uveitis, cataracts, severe secondary glaucoma, and secondary endophthalmitis[10,14]. Therefore, the search for new, effective, and safe treatments of this disease continues.
MitomycinC is an antibiotic with a known inhibitory effect on cell proliferation[15]. It has been used to inhibit regrowth of corneal pannus after surgical excision in patients with atopic keratoconjunctivitis[16]. In addition to its use in glaucoma surgery[17], it has also been used in pterygium surgery[18]. However, the prime density of MMC remains obscure, considering the efficacy and the safety.
In a prospective, randomized and controlled clinical trial, we evaluate the efficacy and the safety of lowdose MMC in the treatment of pterygium. Various densities of MMC were used intraoperatively in the excision of primary pterygium.
MATERIALS AND METHODS
In a prospective, randomized and controlled clinical trial, a total of 550 eyes of 400 patients in our hospital between September 2003 and June 2006 diagnosed with pterygium underwent the excision of primary pterygium barely the sclera, with use or no use lowdose MMC intraoperative. Informed consent for the use of lowdose MMC as an adjunctive therapy in the excision of primary pteygium was obtained from all patients. Preoperatively, all patients understood the nature of the study and criteria for inclusion in the study. Eligible patients included those with primary pterygium, and not complicated with glaucoma, corneal ulcer, uveitis, cataract, keratoconjunctivitis sicca and meibomian gland dysfunction. In all cases, the pterygium extended at least 3mm beyond the limbus. Preoperative evaluation included visual acuity, IOP, extraocular movement, pterygium length (beyond the limbus) Table 1Preoperative characteristics of patients
characteristicsGroup 1
(130 eyes)Group 2
(140 eyes)Group 3
(150 eyes)Group 4
(130 eyes)Age(yr)42.5(3570)42.2(3965)43.1(3266)41.5(3065)Male/Female38/6236/6434/6639/61Average visual acuity0.60.50.50.4IOP（mmHg）1616.51716.3Pterygium length(mm)3.5(36)4(36)3.8(37)4.2(36)Pterygium width(mm)5(36)4.8(36)5.1(36.5)4.6(36)Symptoms(grade) tearing0.80.60.90.7 itching0.60.50.60.7 photophobia0.20.40.30.2 foreign body sensation1.41.31.21.3Signs (grade) hyperemia0.20.120.150.18Extraocular movement0.080.060.040.07
No corneal ulcer, perforation of sclera, ulcer of sclera, iridocyclitis, scarring in each group
Table 2Postoperative characteristics of patients
Group 12wk2mo6mo1aGroup 22wk2mo6mo1aGroup 32wk2mo6mo1aGroup 42wk2mo6mo1aSymptom tearing1.80.60.30.120.80.30.1221.20.30.12.321.60.12 itching10.60.20.121.20.80.40.151.51.30.20.151.51.410.15 photophobia0.20000.30.150.1200.30.20.1500.80.60.30.12 foreign body sensation1.61001.80.8001.80.8002.3210.2Sign hyperemia10001.500020.5002.51.810.2 ulcer of sclera and cornea(eyes)00000000430012800 perforation of sclera (eyes)0000000000000200 extraocular movement (eyes)0888066603330222 iridocyclitis (eyes)0000000000003000 scarring (eyes)0888066633330222Recurrence(eyes)0202627016202206770344
and width (mm), and the following symptoms and signs. Symptoms included itching, tearing, photophobia, foreign body sensation. Signs included hyperemia, ulcer of sclera and cornea, perforation of sclera, iridocyclitis, and scarring. All patients completed a questionnaire and subjectively graded the symptoms, and a masked examiner graded the signs (hyperemia and extraocular movement) noted at the examination on a scale of 0 to 3.
Patients were randomly divided into the four groupsgroup 1:130 eyes of 100 patients, without MMC; group 2: 140 eyes of 100 patients, with 0.2g/L MMC; group 3:150 eyes of 100 patients, with 0.3g/L MMC; group 4:130 eyes of 100 patients, with 0.4g/L MMC, and underwent the excision of primary pterygium, barely the sclera. All operations were performed by the same surgeon with a minimum of 6 months of followup. The symptoms and signs were recorded on the day of enrollment, and after the surgery, on 2 weeks, 2 months, 6 months, and 1 year.
Surgery was performed after administration of topical anesthesia. After the injection of saline solution under the conjunctiva in the body of the pterygium, dissection was continued from the head toward the body. Separated the pterygium from the conjunctiva and Tenons capsule carefully to lacrimal caruncle with conjunctival scissors and forceps, and resected the pterygium tissue from that location. Lamellar keratectomy was not performed when the pterygial tissue was removed from the cornea. A small tampon, soaked with MMC (0.2, 0.3, and 0.4g/L) was placed under the conjunctival valve, and was taken out after 5 minutes. Then the conjunctiva sac was swilled with 50mL saline solution sufficiently. A caliper was used to measure the area of superabundant conjunctiva resected. The conjunctival valve was sutured with 8.0 nylon suture to episclera 2mm away from the limbus.
Postoperatively, the patients were treated with topical dexamethasone and tobramycin solutions four times daily for 2 weeks. The average followup period was 1 year.
The StudentNewmanKeuls test was used to compare the preoperative characteristics of patients (Table 1), and to compare the postoperative characteristics of patients (Table 2). The recurrence was defined as the pterygium extended at least 2mm beyond the limbus.
RESULTS
Table 1 summarizes baseline characteristics including gender, age, average visual acuity, IOP, pterygium length and width, symptoms and signs of preoperative, for the 400 patients who had completed preoperative informed consent. There was no significant difference (P>0.05) among the four groups with regard to these baseline characteristics.
Table 2 shows there was no significant difference of the average visual acuity of postoperative between every two groups (P>0.05). The IOP increased only in 3 eyes of group 4 (2.3%) (P<0.01). Symptoms, including tearing, itching, photophobia and foreign body sensation, of postoperative was statistically significant different between every two groups in terms of severity recorded at the visits of 2 weeks, 2 months, 6 months (P<0.01). And the severity grade of symptoms rose from group 1 to group 4. There was no significant difference in the severity grade of symptoms between every two groups at the visit of 1 year (P>0.05).
With regard to signs of postoperative, eligible patients, compared between every two groups, shared significantly more severity in hyperemia (P<0.05), ulcer of sclera and cornea (P<0.01), perforation of sclera (P<0.01), and iridocyclitis (P<0.01) from group 1 to group 4. And in scarring and extraocular movement, there was significant decline severity from group 1 to group 4 (P<0.05). Ulcer of sclera and cornea, only happened in group 3 and group 4, was 3.3% and 7.6% respectively at the visit of 2 weeks and 2 months. Iridocyclitis, only happened in group 4, was 2.3% at the visit of 2 weeks.
Table 2 also shows that there was statistically significant difference in pterygium recurrence between the every two groups (P<0.01). The percentage of pterygium recurrence was 20.8%, 14.7%, 4.7%, and 3.0% in the group 1, group 2, group 3, and group 4. The recurrence of pterygium declined from group 1 to group 4.
DISCUSSION
Although the multiple types of surgical procedures were described for the treatment of the pterygium, such as radiation therapy, conjunctival autograft[8], and the use of antimetabolites or antineoplastic agents, the high postoperative recurrent rate shows that there is still not a definitive treatment. The ideal surgical technique is one that is efficacious and safe.
In tectology, pterygium is a fibrovascular connective tissue overgrowth of bulbar conjunctiva onto the cornea. The management of pterygium is often difficult. The failure of the treatment of pterygium is often due to its recurrence. Therefore, after the excision of fibrovascular, the inhibition of fibroblasts is the main means to avoid the pterygium recurrence.
MMC, like the other alkylators, has a mechanism of action similar to radiation[19,20] . It selectively inhibits DNA synthesis. At high concentrations, cellular RNA and protein synthesis are also suppressed. Without correctly configured new DNA and RNA molecules, cell migration and mitosis are inhibited, resulting in a decreased rate of cell proliferation. Rapidly dividing cells are most sensitive. For this reason, MMC has been used in ophthalmology extensively, especially in the surgery of glaucoma and pterygium. Although various local side effects have been reported previously[21,22], topical MMC was found to be safe at lowdose[18,23]. We used MMC intraoperatively in pterygium to inhibit the fibroblasts, and ultimately, to avoid the recurrence of pterygium.
This randomized clinical trial, comparing intraoperative use of lowdose MMC in the treatment of pterygium, showed minimal differences in visual acuity between every two groups. It suggested that the efficacy of treatment increased and the safety of treatment declined according with the increase of the dose of MMC. The recurrent rate of group 1 and group 2 were comparatively high. Yet, those of group 3 and group 4 were very low. In group 4, there were iridocyclitis in 3 eyes, perforation of sclera in 2 eyes, ulcer of sclera and cornea in 12 eyes, and elevated IOP in 3 eyes. However, in group 3, there were only ulcer of sclera and cornea in 4 eyes, comparatively. The irritation of MMC increased along with its concentration among 6 months.
In summary, lowdose MMC, in the treatment of pterygium, is effective and safe. Considering the efficacy and the safety, we recommended that 0.3g/L MMC is the best selection in the treatment of pterygium.
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